The concomitance of atherosclerotic subclavian occlusive lesion with coronary artery disease has an extraordinary importance in coronary artery bypass Surgery. The development of a lesion in the subclavian artery proximal to the internal thoracic artery (ITA) before or after coronary artery bypass graft (CABG) by ITA can result with the coronary-subclavian steal syndrome and myocardial ischemia may Occur. It is pretty vital to be aware of the presence of the subclavian occlusive lesion in patients undergoing CABG. We present in this paper an atherosclerotic case that had a concomitant brachiocephalic and coronary artery disease. He had both carotid and subclavian arterial lesions, but also had a carotid endarterectomy with carotid subclavian bypass formerly to CABG because of his objection as a result of the dominancy of his neurological complaints. We discussed the diagnostic methods and the prognosis of brachiocephalic artery diseases concomitant with coronary artery diseases and evaluated the surgical, non-surgical treatment procedures in these patients.